mash
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While in the ICU, you are called to your patient's bedside because of the development of seizure activity in a ventilator patient with nosocomial pneumonia. You review the situation including the medication record. The patient is currently receiving dopamine, one-half normal saline, imipenem/ cilastatin, tobramycin, lisinopril, clonidine patch, and famotidine. The laboratory test results from this morning show normal electrolytes, except for a mildly elevated creatinine of 2.4 that is chronic, and CBC shows an improving white blood count of 15,000. After stopping the acute seizure event, which of the following is the most appropriate next step in preventing further seizures?
A. Stop dopamine
B. Stop clonidine
C. Intravenous phenytoin
D. Change antibiotic coverage
E. CT of the head
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| Idiopathic
Forum Guru
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B. Stop clonidine...
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| Gul
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Imipenem has also seizure potential
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| dariush
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Gul is right Imipenem reduces the Seizure threshold !!!
so i'd go for D.
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| mash
Forum Fanatic
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imipinems ve seizure pot. so, D is correct
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I hear and I forget. I see and I remember. I do and I understand.
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| drdk76
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imipenem reduces seizure threshold in overdosage as well as renal dysfunction---in this case probably due to renal dysfunction.inaddition tobramycin --another antibiotic used here is an aminoglycoside which can potentiate nephrotoxicity--hence the antibiotic profile needs to be changed in this patient whose creatinine is high.
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